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12070246 CITY OF CUPERTINO BUILDING PE'RiMIT BUILDING ADDRESS: 10155 SWAN OAK LN CO:YI'RACI'OR: 1'13'1' RSFN-DIiAN INC PERMITNO: 12070246 OWN'ER'S N,\\IF.: YUHN-WAII SING 7980 EN'1 ERP 121515 UR DA'Z'E ISSUED:07/300012 OWNLR'S PI ION'E: M.-WAIMCA 94560 11110SF.NO:(510)494-9982 LICENSED CONTRACT'OR'S Dl]:CLARATION BUILDINC PE101IT INFO: RLDC r ELECT r PLUMB r License Class _3 Lic.4 1169-d 7 r r r �'�,I MFCIi RESIDENTIAL CO\1 NI F,IiCIA I. Contractor��. e�—YeQ�(f Date 7 30 1 hereby affirm rhal I:nn licensed under the provisions of Chapter 9 .1013 1)ESC RI PTION:TEAR OPT WOOD Sl LAKE AND RI31'IACI:U'I'1'1l COMP (cum nunci ng with Section 7000)of Division 3 of the liusincss S Professions I I4SQUOURAINGLES Code and(hal nn'license is in full farce and effect. I S 0135 I hereby affirm under penalty of perjury one of the fullowin_too declarations: I have and will maintain a cent ticmc of consent to sell'-insure for Worker's Compensation,as provided for by Section 3700 of Elie Labor Code,for the performance of the work for which this penmil is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this 5q. FI Flour Arca: \'aluulion:S6357 permit is issued. APPLICANT CERTIFICATION AIT'Number:34232137.00 Occup:mcYType: I certify that I have read this application and some that the above information is correct. I agree to comply with all city and county ordinances and stale laws re atin_g to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERNUT L\PI RI:S IF WORK IS NO"1 STAR"ITED indenniN and keep harmless the City of Cupertino against liabilities.judgments. costs,and expenses which may accrue against said City in Consequence of-the WITHIN IRO DAYS OF PERIMI1 ISSUANCE OR gunning oflhis permit. Additionally,theapplicator understands and will comply r INSPECTION. Keith all non-poit s c regulations per lbCupertino Municipal Code,Section IRO DAIS FROM LAS"1' CALLED INSI LC"1'10\. 9.18. / _ l 7L Issued by: Signator Dane t ❑ OWN114-RIM-DEIt DECLAILV1'I0N Rh:ROOFS: 1 hereby affirm dual I nor esempl from the Contractor's License Lasv for line of All roofs shall be inspected prior to any r line material being installed. Ifit roof is the following two ryas ns: installed without first olnaining an in a on,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation. inspection. will do the work,and the structure is not intended or offered for sale(Sce.704.1, Business B Profiessions Code) Si at' f Apply til: Date: L as owner of the property,am exclusively contracting with licensed contractors to 0' construct the project(See.7044,Business R Professions Coyle). n1.1.Moor• covh:Rlacs TO 1sh:cl,nss"A^oft BETE I'll I hereby alien under penalty of perjury otic of the follo.vin.-three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker'sIIA%,\RUOIIS \h\'I'h;ItlAl DISCLOSIiIt IC ., Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the haz:wdous materials requirements under Chapter 6.95 of the pedonnance of the work for which this permit is issued. California Ihealth S Safety Code,Sections 2.5.505,35533.and 25534. 1 will maintain I have and sill maintain Worker's Compensation Insurance,as provided for by compliance uviol]the Cupertino Municipal Code.Chapter 9.12 and the I Icalth Section 3700 of the labor Cade,for the performance of the work Ibr which this Safely Code.Section 25532(:)should 1 store or handle hazardous material. Additionally,should [use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance will]the Caper tinoMunicipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the\Porker's Health\S1 fenCode,Sections 255115,25533.and 25534. Compensation laws of Calit'ornia. It after making this certificate of exemption.I become subject to the Worker's Conipensmion provisions Of Elle Labor Code,I nest l 'o 1) r It. Cd gear: Dale: 1 7 ` !Z forthwith comply with such provisions or this permit shall he decnned revoked. CONSTRUM'ION LE.N'DINC M;rNCY APPLIC N'T Cl•:It'fI FICATION I certit'y than I have read this application and state that the above information is I hereby allum that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of This city to enter Lender's Nune upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupcnino against liabilities,judgments. Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ,UtCI II'1'ISC'1"S DECLARATIONwith all non-paint source regulations per the Cupertino Municipal Code.Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 6JSS f[..� or,(` LA DATE: 07/30/2012 REVIEWED Bl': bobs. 2APN: BP#: 'VALUATION: $6,357 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARI' PENTAMATION USE: SFD or Duplex PERMITTI'PE: 1SFDWLR00 WORK tear off wood shake and install comp shingles. SCOPE „ L ,tlech. Plan Check Phunh. Plan Check £lee.Plan Check blech.Permit Fee: Plumb. Permit Fee: Flee.Permit Fee: Other afech. Insp. Other Plumb Insp. Other glee. Insp. ,1•le.ch.hip. Fee: Plumb. hcsp. Fee: Elcc.Imp.Fre: A'OTE: This estimate does not include fees clue to otter Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer.District,School District, etc). These fees are based on the rellninary information available and are will,an estinune. Contact the Dept for adc/n'I in o. FEE ITEMS (Fee Resolution 11-053 E/1' 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1,100 s.f. Re-roof Suppl. PC Fee: Q Reg. O OT 0.0 hrs 50.00 $165.00 IREROOFRES PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Arbninistrative Pee: Q Work Without Permit? 0 Yes (j) No $0.00 G Advanced Plannine Fee: $0.00 Select a Non-Residential G Building or Structure C! Travel Docianentation Fees: A Strong Motion Fee: IBSEIShtCR $0.64 Select an Administrative Item Blde Stds Commission Fee: IBCBSC $1.00 SUBTOTALS:. $1.64 $165.00 TOTAL EEE.,,, $166.64 Revised: 07/01/2012 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT ' BUILDING DIVISION 10300 TORRE AVENUE 'CUPERTINO, CA 95014-3255 (408)777-3228 • FAX (408)777-3333 ' buildinorakuoertino.ora CUPERTINO ` ��yyy PROJECTADDRFS APN0 /J 2� —/97 /97 OWNER NAM-- U em —w C. �w PHONE I I/ aL E.MA✓IL STREET ADDRESS'. l �� CITY ♦ ZIP t FAX CONTACT NAME rM I l< G�-ePAJ TNON5 _ 21 Fs-57 Z E-MAIL SES -REETADDRS 7nC5 / k-f C-ASTATEoZP ^�l �� FAX ❑OWNER ❑ ONT'ER-BUIIDER ❑ OWNERAGENT E CONTRACTOR ❑CONTRACIORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTCAeM�C,I qe�� (ZQO �rN LICENSE Nj14fyEg/`� LICENSE-T'I'E BTA.LIC.tl/•,!� Z 0 COMPANY NAME •�C c 1 E-MAIL'fJrj / s FAX 7 •7 ll STREET ADDRESS - CITY.STATE ZIP PHONE 7 SSDC�sI�r Ise �� Uec�cf` < y56G ARCHITECT/ENG W EER NAME LICENSE NUMBER BIAS.LIC.b COMPANY NAME E-MAIL FAX STREET ADDRESS CITY.STATE.ZIP PHONE USE OF ❑ SFD or Duplex Rf Multi-Family ROOF AREA: VALUATION: Q p STRUCTURE: [D Commercial lot 71-sq-,S 71 /V �j\y+ s�7, EXISTING ROOF TYPE: 13 BUILT-UP ROOF ❑ASPHALT SHINGLES gWOOD SHAKES ❑WOODSHWGLES ❑OTHER(SPECIFY) REMOVE/REPLACE�I'ES IFNO. PLYWOOD Al/s- ❑ PLYWD `p' OSB PITCH: ROOF ❑NO MLA YERS' THICKNESS' ❑ 5B" YPE• ❑COX ')Z CL\SS� A PROPOSED ROOF TYPE ❑BUILT-UPROOF aSPHALTSHINGLES ❑WOODSHAKES ❑WOODSMNGLFS ❑OTHER ICC-FS 3Sq REPORT p ( c FS REP DESCRIPTIONOF WORK: �.��ovL � f S�<- I_ /I/A S� ��-eSICAC'A1-14 I J L fN jES Gal lay my signature below,1 certify to each of the follmving: lam the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have prod ed is wrreet. I have read the Description of Work and verify it is.accurate. Iagree to comply with all applicable local ordinances and slate laws relining to bt l it .0 arocuw, authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: � �X/ Date: SUPPLEMENTAL INFORMATION REQUIRED - OFFICEUSEONLY. - _If building is associated with a home Owner's Association,provide letter PIAN CHECKTYPE`J" i" " ." ROUTING SLIP ofapproval from HOA. vER-TIIE-CouNTEB •t U BUILT PLAN RE\9EW _Provide Planningapproval to verify dthere any restrictions. i I 1 : . I' ' ' -t- PP fY ❑ EXPRESS ❑ PLANT'WC'PLANREVIEW Provide of Manufacturer's Installation Specifications. ' y P ❑ STANDARD " "" ❑ FIRE DEPT rovide sighed copy of Cupertino's Tear-O(T Policy. ❑ OTIIF.R: - ReraojApp_201 I.doc revised 03/16/11